Open to opportunities

Kim Valdez

@kimvaldez

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Utilization review nurse blending clinical care and evidence-based authorization expertise.

Philippines

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What I'm looking for

I’m looking for a utilization review or telehealth-oriented nursing role where I can apply evidence-based guidelines, strengthen medical necessity decisions, and support patients and providers through clear documentation and efficient EMR workflows.

I am a Licensed Registered Nurse with 11+ years of combined clinical and utilization management experience, including bedside care across Medical Surgical Ward, Emergency, Paediatrics, Obstetrics, and the Neonatal Intensive Care Unit. I bring a strong foundation in patient counseling, post-operative care, medication administration, IV management, and confidential documentation—paired with a utilization-review mindset focused on appropriateness and guideline alignment.

For the past several years, I have served in utilization roles such as Utilization Intake Coordinator and Utilization Reviewing/Concurrent Nurse, handling Workers Compensation insurance and authorization requests in inpatient and outpatient settings. I use evidence-based guidelines (ACOEM, NYMTG, ODG, and MCG/Interqual/Interqual) to assess medical necessity using submitted records, coordinate concurrent coverage reviews, and produce clear utilization review reports in EMR/EHR environments (including OLA and Net Health), while supporting clinicians and patients through telehealth-oriented documentation updates.

Experience

Work history, roles, and key accomplishments

Utilization Reviewing Nurse

KMC Solutions Inc

Nov 2022 - Jun 2025 (2 years 7 months)

Reviewed and analyzed medical records against ACOEM, NYMTG, and ODG guidelines to determine the appropriateness and reasonable care for inpatient and outpatient services. Conducted initial clinical coverage reviews using evidence-based guideline criteria.

Utilization Review Medical Record Review ACOEM Guidelines NYMTG Guidelines Inpatient Outpatient Authorization Evidence Based Criteria Case Documentation

Utilization Concurrent Nurse

Cognizant

Dec 2021 - Nov 2022 (11 months)

Performed clinical reviews and applied clinical criteria for prospective, retrospective, and concurrent authorization requests in inpatient and outpatient settings. Utilized MCG/Interqual to determine authorization support based on established guidelines.

Utilization Management Concurrent Review Retro Authorizations Medical Record Review

Utilization Intake Coordinator

EXL Service Philippines

Jul 2016 - Dec 2021 (5 years 5 months)

Processed incoming authorization requests by entering compensability, demographic details, requesting providers, and attorneys into the system. Coordinated with supervisors and reviewers to evaluate completeness of source documents, identified missing information, and prepared utilization review reports aligned to client/state guidelines.

Utilization Management Workers’ Compensation Authorization Clinical Documentation Daily Case Monitoring Data Entry

Ward Nurse

Fairview General Hospital

Feb 2013 - Dec 2014 (1 year 10 months)

Applied the nursing process to assess, plan, provide, and evaluate care based on patient and staff interviews. Provided post-operative care, managed pain, administered medications, performed dressing and IV care, and supported admissions, discharges, and transfers.

Medical Surgical Nursing Pain Management IV Therapy Dressing Changes Patient Transfers

Emergency Nurse

Fairview General Hospital

Oct 2012 - Feb 2013 (4 months)

Assisted physicians with treatments and diagnostic tests, including minor surgical operations, and prioritized care for patients with trauma or injury. Counseled patients and families and maintained concise, complete nursing records and reports.

Emergency Nursing patient assessment Trauma Prioritization Diagnostic Tests Minor Procedure Assistance Nursing Documentation Patient Counseling